FAMILY PLANNING ELEVATED Expanding Access to Contraceptive Services in Utah

Etonogestrel (hormonal) implant

The hormonal implant is a small, plastic, hormone-releasing rod that is inserted in the inner upper arm by a provider. The implant releases the hormone progestin, which suppresses the ovaries from releasing the egg, and thickens the cervical mucus, preventing sperm from reaching the egg. The implant can prevent pregnancy for up to 4 years.

The implant is commonly referred to by its brand name, Nexplanon.

Levonorgestrel (hormonal) IUD
This small, plastic device is inserted into the uterus by a provider, and can be effective at preventing pregnancy for 3-7 years. Once the provider inserts the IUD, there is no maintenance required from the user. There are four FDA-approved hormonal IUDs that release progestin into the uterus. The progestin suppresses the ovaries from releasing the egg, and thickens the cervical mucus, preventing sperm from reaching the egg.

Some types of hormonal IUDs include: Liletta, Mirena, Kyleena and Skyla.

Instead of using hormones to prevent pregnancy, the Paragard IUD is made of copper, which deters sperm from reaching the egg. This small device is inserted into the uterus by a provider and can be effective at preventing pregnancy for up to 12 years.  Once the provider inserts the IUD, there is no maintenance required from the user.

The ring is a small, one size fits all, flexible round piece of plastic that the user inserts into their vagina. It contains estrogen and progestin, which suppresses ovulation. Each ring can be used for 3-4 weeks and then must be replaced.

The patch is a thin, beige, square piece of plastic with an adhesive on one side. A person places a patch on their skin either on the pelvis/hip bone, shoulder blade area, or buttocks. The patch contains hormones – estrogen and progestin – which stops ovaries from releasing eggs. The patch is replaced every week. The patch may be less effective for people who weigh more than 198 pounds.

Combination estrogen and progestin – the combined pill uses synthetic estrogen and progestin to prevent the body from ovulating (releasing an egg for fertilization). To use pills correctly, a person begins to take them and uses condoms for the first seven days. Pills should be taken every day, in order for them to be most effective. If a person misses a day of pills, they should take two pills on the next day. If they miss two days of pills, they should take two pills that day and then two pills the next day. If they miss more days, they should begin taking pills as soon as they are able and use condoms for the next 7 days.

Progestin only “minipill” – progestin only pills use synthetic progestin to prevent the body from becoming pregnant by thickening the cervical mucus so sperm cannot get in to the uterus or fallopian tubes. To use progestin-only pills correctly, a person begins to take them and uses condoms for the first seven days. Progestin-only pills must be taken at the same time every day, in order for them to be most effective. If a person does not take their progestin-only pill within the same three hour time frame, they should take the pill when they remember and use a condom for at least two days.

The shot is an injection of the drug Depo-Provera (Depo) that an individual receives from their provider once every three months. Depo contains the hormone progestin which suppresses the ovaries from releasing eggs. It also thickens the cervical mucus which prevents sperm from reaching the egg.

The external condom fits over the penis and prevents pregnancy by catching sperm to prevent it from entering the vagina. External condoms can be made from different materials, but most commonly are made of latex. To use an external condom correctly, the condom is rolled over the penis, leaving a little room at the top to catch the ejaculation. The condom should be applied before the penis has any contact with the vulva/vagina. People should use a new external condom each time they have sex. If the condom breaks during sex, individuals have the option to use emergency contraception.

The internal condom is a non-latex pouch that is inserted inside the vagina near the cervix, while an external ring remains outside of the vagina.

The diaphragm is a silicone cup that is inserted into the vagina that prevents sperm from having access to the cervix (and thus, stops them from fertilizing an egg). The diaphragm should always be used with spermicide. A diaphragm can be in the vagina for up to 24 hours. To use a diaphragm correctly, put spermicide into the cup before putting the cup into the vagina and fitting it up against the cervix. After having sex, leave the diaphragm in for at least 6 hours. Diaphragms shouldn’t be used when someone is on their period. Most diaphragms require a user to go to a doctor to get fitted, but the Caya diaphragm is “one size fits most.” Your provider can write you a prescription for Caya, and you can ask for a test unit to try it out first.

The cervical cap works in a similar way to the diaphragm, but is a different shape, is smaller, and can be in the vagina for up to 48 hours. To use a cervical cap correctly, put spermicide into the cap before using (make sure to use a water-based spermicide/lube, since other types will degrade the cap) and insert into the vagina and cover the cervix. After having sex, leave the cervical cap on for at least 6 hours. Cervical caps shouldn’t be used when someone is on their period. Most cervical caps require a user to go to a doctor to get fitted, but the Femcap cervical cap is available without needing a traditional fitting. Your doctor can prescribe the FemCap for you based on your pregnancy history.

The sponge is a soft plastic sponge that contains spermicide. It fits over the cervix and prevents sperm from accessing the cervix (and thus, stops sperm from fertilizing an egg).

Spermicide is a variety of chemical gels and creams that is inserted deep inside the vagina prior to sex to prevent sperm from reaching the egg. Spermicide is available over the counter at most pharmacies, and doesn’t require a visit to a provider.

You might also have heard of these referred to as “natural family planning” or “fertility awareness.” These names actually refer to several different kinds of methods.

In order to use a FABM method, individuals need to menstruate/have a period regularly. This is because FABM methods use signs from the body to determine whether a person can become pregnant on a particular cycle day. This means that people who use hormonal contraception methods (like pills) or who are on other medications that affect their menstrual cycles, or who have health conditions where their cycles are irregular, should probably not use these types of methods.

For people who menstruate and want to use these methods, there are several to choose from. Different FABM methods rely on different signs/symptoms to determine that day’s fertility. The ability to use these methods successfully requires several things, including: 1) an ability and comfort in observing one’s own body signals, 2) a partner’s willingness to abstain from sex or use a condom during a fertile window, and 3) other aspects of one’s individual health and lifestyle (including things like whether or not someone has regular periods, or works at night, etc).

Not every “natural” method is considered a FABM method. For example, there are many “fertility” apps that might give someone information about their ability to become pregnant. However, the majority of fertility apps haven’t been scientifically tested and many have been shown to give people incorrect information. If you choose to use a FABM method, it’s important to use methods that have been scientifically tested.

Breastfeeding/Chest-feeding/Lactational Amenorrhea (LAM): This method relies on lactational amenorrhea (lack of a period due to lactation) to prevent pregnancy. In the initial time after giving birth, when the baby latches onto the nipple, hormonal signals are sent to the brain to stop ovulation from happening. This method can only be used by people who have had a baby and exclusively breast/chest feed on demand (frequently throughout the day and night). The method can be used for up to six months after childbirth. This method isn’t effective for people who need to use a breast pump, formula, or who aren’t able to feed at least every four hours during the day and every six hours during the night.

To use withdrawal as a method of contraception, a person “withdraws” or “pulls out” their penis from the vagina before they ejaculate/come. To practice this method correctly, they should make sure that their semen doesn’t come into contact with the vulva/vagina. They should also make sure that they urinate between sex acts (including masturbation), to clear out sperm that may still be inside their penis.

Abstinence as a method of family planning means that 1) there is no time where a penis is inserted in a vagina; and 2) semen from a penis doesn’t come into contact with a vulva or vagina. Abstinence means different things to different people, but from a contraceptive perspective, it simply means that there’s no opportunity to become pregnant because there hasn’t been any vagina/penis interaction.

Tubal ligation or “getting tubes tied” is a surgical procedure performed by a provider where the fallopian tubes are closed or blocked. Tubal ligation prevents pregnancy by eliminating the physical pathway for the sperm to travel to fertilize the egg. Tubal ligation is a permanent form of contraception

Vasectomy is a surgical procedure performed by a provider where a small incision in the scrotum is made, and the vas deferens (the tubes that carry sperm) are cut so that sperm cannot leave the body to cause a pregnancy. Vasectomy is a permanent form of contraception.

Emergency Contraception/”Morning After” pill(s):

Emergency contraception can prevent a pregnancy before it starts. There are three types of emergency contraception:

Copper IUD

The copper IUD is the most effective form of emergency contraception. The copper IUD can be inserted within five days of contraception failure or unprotected sex, and can act as a form of contraception for up to 12 years after placement. An appointment with a provider is required to obtain this method of emergency contraception.

Ella

Ella is a single pill taken up to five days after birth control failure or unprotected sex. Ella is more effective than Plan B, particularly if it’s been more than three days since sex, or for individuals who weigh more than 165 pounds. A prescription from a provider is needed to get this form of emergency contraception.

Plan B

Plan B, or more commonly known as the “morning after pill” is a single dose pill taken within 72 hours after birth control failure or unprotected sex. Plan B can be obtained over-the-counter, without an appointment with a provider, but is not as effective at preventing pregnancy for individuals who weigh more than 165 pounds.

Check out this video for more information!

https://www.youtube.com/watch?v=_Q2E8tsyCQE